Patients' Perceptions of Nurses' Skill

I subscribe to several nursing journals, one of which is "Critical Care Nurse" - published through the AACN (American Association of Critical Care Nurses) and I really do try my best to read all of the articles in each one, but honestly, only get time to skim through the magazine and read the articles that pertain directly to my career or articles where the title catches my eye.

Every once in awhile an article comes along that I love. Heck, I've even been known to rip out an article and put it in the nurses' lounge at the hospital a time or two. In September 2009, they published an article titled "Patients' Perceptions of Nurses' Skill" which I read and loved. The article discusses the factors that our patients use to assess our skill level. How do the factors that they use differ from the factors you use to look at your own nursing skill, or the skill of your coworkers?

Nursing practice has three domains that make up skill: interpersonal, critical thinking, and technical. Which of these can our patients most easily pick up on? Interpersonal, of course. Our patients have very little insight into our critical thinking skills. As they lay in bed trying to breathe post-extubation with stridor, they don't know that you're the one calling the doctor for racemic epi, IV steroids, and heliox because you know the cause of the stridor. The same is true with our technical skills. Sure, they see us removing their central line, but they don't know correct steps to tell if you're performing the procedure in conjunction with best practice standards. All that our patients can see is our attitude about these things. When you call the physician on your patient with respiratory stridor, they see that you are doing this quickly and with confidence. You are in the room reassuring them that things will be okay and educating them on what is happening. When you are pulling the central line, you are explaining each step to the patient to reduce their stress level about the procedure and possibly chatting about another topic to get their mind off of it and show interest in them as a person.

I highly suggest reading the article (I've attached the PDF below), but the big take-aways for me were:

Patients describe the attributes of skilled nurses as: friendly, caring, compassionate, kind, good listener, confident, enjoyed his/her job, well-organized, and followed through with tasks he/she said they would do

So, I look at these terms that our patients use to decipher our nursing skill and I can see the affect on our unit. There are a certain group of nurses who often get thank you cards or small tokens of appreciation from patients and family members and they display off of the attributes of skilled nurses - seems that this article is telling the truth

This article helps me remind myself when my day is going horribly, to take a breath. You're getting paid to be at work and these patients/families are going through a hard time right now. Relax and do your job, they don't need to know that you just got chewed out by a jerk physician or that the patient next door is confused, crawling out of bed, and on your last nerve. When you go in the room to do something, do it with a smile and take the extra time to try and make a connection with each one of your patients. You will stand out as they remember their hospital stay and you will personally feel better for having a relaxed attitude.

I may have to work 15 minutes longer. I am "slow" as the fast nurses say, that within 45 minutes of beginning our shift, assessments are done, meds are passed. They are the ones that sit around the Hucs station and talk about men, love....each other..worse MEE!! But, nursing is my job, is what I do. My job is to put those patients who lie in that bed, who haven't been in a hospital bed in 24 years, minds at ease. I ask about their family, their lives at home, their pets. I tell them everything that I am doing in the room. This is your antibiotic that I am hanging..we want to kill any germs that may have snuck in while we weren't looking. I walk them to the bathroom. I clean up their bed, if they wet and I think they may be embarrassed, I tell them everyone does it or I tell them I'll clean them right up. I bring them any requests, water, peanut butter etc...within minutes, knowing it may put me behind a little. They don't know we have 6 other patients and its not their job to know. They need to get well. I tell them to make themselves at home..ya can't break the bed! I am sure I say outloud as I am leaving "can you reach your things, what cha going to do to call me for any little thing? So many many times I hear "if all the others were like you...it'd be so good" or "I tried to tell other nurses that my husband isn't taking this pill....would you check on it (it'd be a fluid pill! or some heart pill that got left off their med list by someone's mistake). I am a new RN, over 50 years old, breaks are not my priority (they aren't long enough!! lol) I work nights and barely have time to eat. But I know this, some folks you just can't please, they are mad at the world, as the movie Tombstone says "sorry for ever being born". But, there are so many more that are scared of the new white coat environment who tell me "those other nurses act like robots, they come in, they do their job...which is ok...but scary to me...they don't say much", but you make us feel like - well, you care. THAT! MY FELLOW WORKERS...is worth any breaks missed, your gossipping at the huc's desk is mean and puts everyone in a foul mood within earshot of your flapping beak - you may think your Queen LaNursa but deep down everyone doesn't like your negative mouth, its unbelievable your so mean, those that listen to you...are weak and just don't want you to talk about them... and then...they - the weak, infected with your limelight, in turn talk about you as you leave the huc. Monkey see, Monkey do..every single time. Its a big waste of time.

Our hospital, because of the cell phones, Super Large drinks...has banned everything..even coffee at the desk..because a patient who was being ignored by their nurse was too busy playing at the HUC's station. So many were texting their boyfriends or hubbys at home. Guys were playing cards on the phones. Well, bad apples that spoil it for everyone..cell phones are banned, they are cracking down on smoking breaks, magazine reading, crossword puzzles. You just can't ignore the patients. Patients who aren't happy aren't going to be liable for any services according to Medi....and you may be good at skills and saving lives but if your heart ain't in it...your floor manager will say "well, she, may be good in a code...BUT SHE is NOT a good nurse, patients can't stand her Better than Thou attitude!"....I have heard it myself on on of my favorite hateful coworkers.

Take a moment, put yourself in that bed, tell that patient what your doing...or something as simple as "hey, I got your labwork back..you know when they drew your blood this am...?? well, I just want you to know, I'm happy that your bloodwork is super duper", or as you leave a patient's room.."I'll be making rounds again but it may be an hour or I might get stuck...you sure you don't need something before then..I'm trying to take good care of you". Yeah, I may be a little slower, but I know at the end of the day, when I think of the hug I got from a patient, I feel good about my sacrifices.

I'm a nursing student whose only hospital experience has been with myself and my family in the hospital. I'm trying to keep in mind what I felt when I was in the hospital as I go through clinicals. I know that right now, I won't be as adept at anything as the experienced nurses, but I do know that I can be human. I've got lots of experience at that. (And, also trying to remember to not let patients necessarily side-track me...a balancing act that you seem to have down pat. )

When I was pg with my second child, I was going to be induced. My first decided to come on his own. I went with my husband to the hospital at the appointed time, and the nurse was running around getting everything read, and she told me to do this and do that. I was scared about being induced, but I didn't know it until I got to the hospital. I remember going to the bathroom in my room, and I started crying. My husband heard me, and he came in, asking, "What's wrong? What's wrong?" I said, "I don't know. I think I'm scared about being induced, but the nurse is just running around getting all these scary things ready and telling me what to do, and she isn't talking to me at all!"

My husband went out and talked to her. When I came out of the bathroom in my gown, she gave me a smile and said, "I'm sorry. This is your second baby, and I didn't think you'd be scared. It's ok. Do you want to ask me anything?"

I just smiled and said, "Are you doing all these things because you know something is wrong?"

She answered, "Oh, no, no. We just do these things because you're being induced. Nope. Nothing is wrong."

I felt so much better.

I'm forever grateful to her...and to all the nurses like her. I want to be like her. But maybe proactively.

This shows that honey attracts more flies than vinegar. In other words, patients gravitate toward the nurses who display confidence and warm bedside manners. They do not like the nurses who are abrupt or lacking in social skills.

The delivery of the care is sometimes more remarkable than the care itself.

[quote=camoflower;4169873]I may have to work 15 minutes longer. I am "slow" as the fast nurses say, that within 45 minutes of beginning our shift, assessments are done, meds are passed. They are the ones that sit around the Hucs station and talk about men, love....each other..worse MEE!! But, nursing is my job, is what I do. My job is to put those patients who lie in that bed, who haven't been in a hospital bed in 24 years, minds at ease. I ask about their family, their lives at home, their pets. I tell them everything that I am doing in the room. This is your antibiotic that I am hanging..we want to kill any germs that may have snuck in while we weren't looking. I walk them to the bathroom. I clean up their bed, if they wet and I think they may be embarrassed, I tell them everyone does it or I tell them I'll clean them right up. I bring them any requests, water, peanut butter etc...within minutes, knowing it may put me behind a little. They don't know we have 6 other patients and its not their job to know. They need to get well. I tell them to make themselves at home..ya can't break the bed! I am sure I say outloud as I am leaving "can you reach your things, what cha going to do to call me for any little thing? So many many times I hear "if all the others were like you...it'd be so good" or "I tried to tell other nurses that my husband isn't taking this pill....would you check on it (it'd be a fluid pill! or some heart pill that got left off their med list by someone's mistake). I am a new RN, over 50 years old, breaks are not my priority (they aren't long enough!! lol) I work nights and barely have time to eat. But I know this, some folks you just can't please, they are mad at the world, as the movie Tombstone says "sorry for ever being born". But, there are so many more that are scared of the new white coat environment who tell me "those other nurses act like robots, they come in, they do their job...which is ok...but scary to me...they don't say much", but you make us feel like - well, you care.THAT! [quote]

Way to go camoflower! I'm new and slow too, but my patients know I care. I may not be able to start every IV but I can always find someone who can for me (Fortunately I do work at a good hospital where we don't place the patient in undue stress). Interacting with the patients is what it is about I want my patients to know that I actually CARE. Who cares if it does take more time, they are worth it and they are the reason we have a job in the first place(Job security).

I may feel SO rushed with all I have to do but I don't ever let the patient know that.

Patients (and people) want to know that you care before they care what you know.
This article is an excellent example of this.

With doctors, it is the reverse. A doctor can behave like a pig's butt and people will accept that, even if he is a walking disaster clinically. That bedside manner can be cr*p in a doctor and he can be a total klutz. But the MD after his name grants him immunity from having to be nice or even be competent - at least, for a long time, with a lot of people.

Let a nurse have a scowl or even just be busy and she will be judged most harshly. Especially if the nurse has no male sex organs. Sorry, but it's true.

I may have to work 15 minutes longer. I am "slow" as the fast nurses say, that within 45 minutes of beginning our shift, assessments are done, meds are passed. They are the ones that sit around the Hucs station and talk about men, love....each other..worse MEE!! But, nursing is my job, is what I do. My job is to put those patients who lie in that bed, who haven't been in a hospital bed in 24 years, minds at ease. I ask about their family, their lives at home, their pets. I tell them everything that I am doing in the room. This is your antibiotic that I am hanging..we want to kill any germs that may have snuck in while we weren't looking. I walk them to the bathroom. I clean up their bed, if they wet and I think they may be embarrassed, I tell them everyone does it or I tell them I'll clean them right up. I bring them any requests, water, peanut butter etc...within minutes, knowing it may put me behind a little. They don't know we have 6 other patients and its not their job to know. They need to get well. I tell them to make themselves at home..ya can't break the bed! I am sure I say outloud as I am leaving "can you reach your things, what cha going to do to call me for any little thing? So many many times I hear "if all the others were like you...it'd be so good" or "I tried to tell other nurses that my husband isn't taking this pill....would you check on it (it'd be a fluid pill! or some heart pill that got left off their med list by someone's mistake). I am a new RN, over 50 years old, breaks are not my priority (they aren't long enough!! lol) I work nights and barely have time to eat. But I know this, some folks you just can't please, they are mad at the world, as the movie Tombstone says "sorry for ever being born". But, there are so many more that are scared of the new white coat environment who tell me "those other nurses act like robots, they come in, they do their job...which is ok...but scary to me...they don't say much", but you make us feel like - well, you care. THAT! MY FELLOW WORKERS...is worth any breaks missed, your gossipping at the huc's desk is mean and puts everyone in a foul mood within earshot of your flapping beak - you may think your Queen LaNursa but deep down everyone doesn't like your negative mouth, its unbelievable your so mean, those that listen to you...are weak and just don't want you to talk about them... and then...they - the weak, infected with your limelight, in turn talk about you as you leave the huc. Monkey see, Monkey do..every single time. Its a big waste of time.

Our hospital, because of the cell phones, Super Large drinks...has banned everything..even coffee at the desk..because a patient who was being ignored by their nurse was too busy playing at the HUC's station. So many were texting their boyfriends or hubbys at home. Guys were playing cards on the phones. Well, bad apples that spoil it for everyone..cell phones are banned, they are cracking down on smoking breaks, magazine reading, crossword puzzles. You just can't ignore the patients. Patients who aren't happy aren't going to be liable for any services according to Medi....and you may be good at skills and saving lives but if your heart ain't in it...your floor manager will say "well, she, may be good in a code...BUT SHE is NOT a good nurse, patients can't stand her Better than Thou attitude!"....I have heard it myself on on of my favorite hateful coworkers.

Take a moment, put yourself in that bed, tell that patient what your doing...or something as simple as "hey, I got your labwork back..you know when they drew your blood this am...?? well, I just want you to know, I'm happy that your bloodwork is super duper", or as you leave a patient's room.."I'll be making rounds again but it may be an hour or I might get stuck...you sure you don't need something before then..I'm trying to take good care of you". Yeah, I may be a little slower, but I know at the end of the day, when I think of the hug I got from a patient, I feel good about my sacrifices.

That's all very nice, I wish you staying power! You say you're new and it does show. I hope your newness never wears off.

But for those of us who've been on this treadmill for decades, it's different. Our naivete is gone. OUr eyes see how our bosses use and abuse us. We have old times to compare to the present and we see that we are expected to work at a terrible pace, take no rest breaks, work mandatory shifts of overtime, take more and more patients, smile more, explain more, spend more time waiting on visitors, and catching abuse from families who are angry at the doctors. Those, I give the doctors' phone numbers to. Let them yell at the right persons.

And a hug is nice, kind words of appreciation are nice, but I feel foolish for working as hard as I do when the other staff get paid the same and get to take their breaks! And then to get criticized for stuff I thought I was doing well but which the supervisor didn't like but never bothered to tell me til eval time, forget it. It's all demoralizing. I do the minimum, I admit. No more volunteering to work OT, calling docs for orders that will keep til they round, doing the work of other disciplines or fetching charts or chairs for doctors, forget it. Nobody helps me or even appreciates me - or will be honest with me.

Just wait til you are betrayed and let's see you keep that smile in your heart. I hope you're made of better stuff than I am.

I will never forget the nurses (and a fantastic NP) who cared for my mom at the oncology clinic (she had multiple myeloma - 81 at diagnosis - we knew it would likely be fatal). We chose to go to a clinic that was farther away because it was smaller and she would have a couple of nurses that would always care for her. They were the ones who listened to me, her caregiver. They hugged me when I would go out to cry in the hall on rough days. They listened to me and respected that I knew a lot more about my mom than they did (I was not a nurse at the time but they still listened and respected what I knew from being with her day to day). They advocated for us when a change needed to be made. They always acted glad to see us and would treat her like a person. They made a tough situation easier to bear.

When I decided to put her into hospice care, they supported it (even though the doctor opposed it - she died 2 weeks later) but assuring me that my brother and I had always provided great care to my mom (their way of saying they agreed without outright disagreeing with the doctor). Our hospice nurse was great. At her first visit, she said to me, "What would you like me to do for your mom?" I said, "Stop everything except pain meds. No more INR, etc." She said, "I can do that. I'll call the doctor and get the order." I felt like she respected that we as her family knew her best.

I will never forget these nurses. Did I want them to be competent? Sure but it was also important that they cared. The little things they did made a huge difference. I hope I am that kind of nurse to my patients.

Every time my husband was hospitalized he was very impressed with the young, pretty RNs and allowed'm to get away with everything... They could've tried to kill him, and he'd still be happy just to see'm walking in/out of his room, trying so hard to have everything done right, and following every questions with "I'm not sure, but I promise I'll get back to you ASAP" lol
Anyway, last time we were in the hospital, I was very touched by an older nurse who nailed his diagnosis withing 15 minutes of reading his chart and talking to him for a while, she came in to help the young RN who was having trouble with his NG tube, and took the time to assess him, and talk to me (I was holding 2 little kids and he was sitting there for 7 days with heart problems and no explanations to what was wrong with him). When we left the hospital, the cardiologist still could not tell us what had triggered my husband's heart, or how it reversed itself into a proper rhythm. We chuckled, we wanted to have the RN come in and explain to him... But we just thanked him and left with our discharge papers... Followed nurse's orders and hubby has not had any heart problems since, that was 2.5 years ago!
Moral of the story: Every nurse has something to give!! Young or old, new or seasoned!